Mortgage Life Has Changed!


You will never want to replace this policy. Discover the most consumer friendly Mortgage Life Plan in existance today. Five benefits (Life Insurance for the duration of your mortgage, Disability, Chronic & Critical Illness Protection, Accidental Death) in one plan for the duration of your mortgage and it is transferrable should you move. Best of all, receive 100% of your money back if no benefits are claimed.
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ONE POLICY--ONE PREMIUM--ONE COMPANY--ONE AGENT--NO HYPE--NO PRESSURE--NO KIDDING
SIMPLY THE BEST VALUE FOR YOUR INSURANCE DOLLAR!
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*************ADVANCED MORTGAGE PROTECTION'S RAPID ACCUQUOTE***************
To secure the BEST RATE the first time, please provide all the requested information below. Your rates will depend upon accurate information. You will receive our response approximtely 24 hours from the time we receive your request. Just print, complete, and fax back to us at: (972) 329-5557 or e-mail us with this information at the address below.

Name(s):_________________________________________________________
Address:___________________City____________ State_____ Zip ______
Telephone No. Home: ____________ Work:________________ Ext ______
Mortgage Company:_________________________Balance:$______________
Mortgage Payment:$_____________Term:__________________
DI Coverage at work? (Borrower) Yes____No____ (Spouse) Yes____No____
Annual Income: (Borrower) $______________________ (Spouse) $___________________
Occupation: (Borrower)______________________ (Spouse) ___________________

Health Questions:

Tobacco? Dip? (cigarettes,pipe,cigar) (Borrower)Yes ___ No ___ (Spouse)Yes ___ No ___
High Blood Pressure or Cholesterol? (Borrower)Yes ___ No ___ (Spouse)Yes ___ No ___
Diabetes? # units of insulin) (Borrower) Yes ___ No ___ (Spouse) Yes ___ No ___
Treatments: Heart/Liver/Lung/Brain (Borrower)Yes ___ No ___ (Spouse)Yes ___ No ___
Havw you been in hospital in the past 5 yrs? (Borrower)Yes ___ No ___ (Spouse)Yes ___ No ___
Cancer? (Borrower)Yes ___ No ___ (Spouse)Yes ___ No ___
High Risk Activities? Fly, Race) Borrower)Yes ___ No ___ (Spouse) Yes ___ No ___
Height/Weight (Borrower)_____ft _____in/_______lbs (Spouse)_____ft_____in/_______lbs
Present Life Coverage: Term _____ WL _____ UL _____ VL _____


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